Heidi Murkoff & Arlene Eisenberg & Sandee Hathaway What to Expect the Toddler Years (v5.0)
HAT TO
W E T T Y Heidi Murkoff Arlene Eisenberg
Sandee Hathaway, B.S.N.
Sharon Mazel Foreword by Morris Green, M.D., F.A.A.P. Perry W. Lesh Professor of Pediatrics Indiana University Medical Center
Copyright © 1994, 1996, 2009 by
What to Expect LLC
Book illustrations copyright © 1994, 2009 by Marika Hahn
What to Expect® is a registered trademark of What to Expect LLC.
All rights reserved. No portion of this book may be reproduced—mechanically, electronically, or by any other means, including
photocopying—without written permission of the publisher.
Published simultaneously in Canada by Thomas Allen & Son Limited.
Library of Congress Cataloging-in-Publication Data is available
ISBN 978-0-7611-5214-9
Material in “What Your Toddler May Be Doing Now”:
Adapted from the Denver Developmental Materials, W. K. Frankenburg, M.D.
By permission of the author. Height, Weight and Head Circumference Charts, pages 862–65:
Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and
Health Promotion (2000).
Book design: Lisa Hollander with Janet Vicario
Front cover illustration: Tim O’Brien based on a photograph by Penny Gentieu/babystock Back cover illustration: Tim O’Brien based on
a photograph from Getty Images Cover quilt: Lynn Parmentier, Quilt Creations,
Quilt photography: Davies + Starr
Book illustrations: Marika Hahn
Workman books are available at special discounts when purchased in bulk for premiums and sales promotions as well as for fund-raising
or educational use. Special editions or book excerpts can also be created to specification. For details, contact the Special Sales Director
at the address below.
Workman Publishing Company, Inc.
225 Varick Street
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Manufactured in the United States of America
First printing 2009
60 59 58 57 56 55 54
Note: All children are unique and this book is not intended to substitute for the advice of your pediatrician or other physician who should
be consulted on toddler matters, especially when a child shows any sign of illness or unusual behavior.
To Elizabeth, the toddler we could always turn to; and to Emma, Wyatt, Rachel, and Ethan,
whose toddler years are gone but certainly not forgotten.To Howard, Erik, and Tim, our partners in parenting, and our very best friends.
ACKNOWLEDGMENTS
A Million Thanks
Much like the eight toddlers we’ve had the pleasure of parenting, What to Expect the Toddler Years has presented us with countless challenges. And in the four years that it has taken us to research, write, and produce it, we’ve been lucky enough to work with many wonderful people who have assisted us in facing those challenges. Now, with the book in hand (make that two hands; at 900 plus pages, one hand won’t do), we’d like to take the opportunity to express our thanks to those who have helped put it there:
All the readers of our previous books, not only for their input, insights (keep those cards and letters coming!), and their loyalty (so greatly appreciated), but for their patience as they waited (and waited, and waited) for this book’s arrival.
Elizabeth Hathaway, toddler-come-lately, for obligingly posing for countless knock-knee photos, for always doing everything “by the book,” and for generally being the right age at the right time.
Dr. Morris Green, our esteemed and distinguished medical advisor, who never flinched (at least visibly) at the endless piles of paper we sent him, who painstakingly crossed our medical t’s and dotted our medical i’s, who brought not just scientific knowledge, but great sensitivity to the task, and who worked at laser speed no matter how busy he was on other projects.
Suzanne Rafer, our intrepid editor and good friend (she’d have to be), who waded through the sea of manuscript with her usual grace, style, sense of humor, and more “flags” than the United Nations will ever see.
The entire Workman team and extended family, but especially Lisa Hollander and Janet Vicario for their artistic expertise; Judit Bodnar for perceptive copy-editing, and Joan L. Giurdanella and Rob Sternitzky for attentive proofreading; David Schiller for copy that lets readers tell our books by their covers; and Peter Workman for his wisdom, understanding, and patience.
Marika Hahn for adorning the book with so many adorable toddlers. Dr. Mark Widome for his invaluable support and assistance, particularly on matters of toddler safety and first aid. And the many others who’ve lent their expertise, including Carole Marcus, M.D.,
J. Rutt Reigart, M.D., Kathy Leonard, M.D., Al Mooney, M.D., Shelly Bazes, C.N.P., W. K. Frankenburg, M.D., Beverly Bresnick, Cate D’Amboise, Sara Jacobs, Ann Wimpheimer, Alan Friedman, Sue Kellerman, Wendy Sax, Barbara Braun, Susanna Morgenthau, Mimi Gelb, Eve Coulson, Aliza Cotton, Michael Rand, and the moms and dads who’ve plied us with questions at our parenting groups and seminars.
The terrific staff at the American Academy of Pediatrics, including Michael Copeland, Carolyn Kolbaba, Leslee Williams, and former staff member Michelle Weber, for helping to keep our books accurate and up-to-date.
The editors of Contemporary Pediatrics for invaluable assistance whenever called upon; Juliann Goldman of C.S.P.I.; and N.A.P.N.A.P.
Tameka Hall and Niurka Zameta, crackerjack assistants, who kept up with filing mountains of articles from journals and newsletters, checked phone numbers, and otherwise kept our office going.
Abby and Norman Murkoff and, as always, Mildred and Harry Scharaga for unflagging support.
Contents
Safety Warning Selecting Shoes for the Walker Parting Tips
Introducing Cow’s Milk How to Wean From the Breast Generalizing
Other People Have Feelings, Too
Toys for Tots Early in the Second Year Containing the Clutter Buy Right
HAPTER HREE HE
C T : T F M
Keep It Cool When the Cow’s the Culprit Now I Lay Me Down to Sleep Birthmarks, A Year Later
Pet Prescriptions
Setting Up a Play Group
Win-Win Solutions Make Discipline a Laughing Matter To Spank or Not to Spank When Spanking Becomes Abuse Never Shake a Toddler
HAPTER
IX HE
C S : T E M
Slumber Diary Safe Seating A Spoonful of Sugar Toys, Playthings, and Activities at Eighteen Months
Energy Outlets for Tots Relaxation Techniques for Tots
Taming Aggression Play-Date Guidelines “Type A” Kids Talking It Out Living with Your Difficult Toddler Try It Quiet
What’s That Pitter Patter? Facing Fears When Little Fears Get Too Big
HAPTER
INE HE WENTY
C N : T T -F M
WHAT YOU MAY BE WONDERING ABOUT
Teaching Time You’re Not Alone Is It Time to Take Them Out to the Ball Game (or a Movie, or Play, or Concert?) Making Routines Routine
Shopping with Toddlers: Mission Impossible
Don’t Leave Home Empty-Handed Leaving the Country Traveling Toddler’s Tummy Junior Jet Lag Tantrums on the Go
A Ticklish Situation Cheer Achievement ... But How Much?
Happiness Is a Warm Parent ...
WHAT IT’S IMPORTANT TO KNOW: Building Self-Esteem
WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: The Importance of Fitness
Block the Ouch! Tell It Like It Is Nighttime Protection Nightmares vs. Night Terrors
To Grandmother’s House We Go Toys for Tots—at Two Years
Tantrums Aren’t Just for Kids
Cholesterol Levels in Children Talking to Your Toddler at Two
Copy Cat Getting Creative With Techniques
HAPTER OURTEEN HE TH TO TH ONTHS
C F : T
28
30 M
Into the Swim? Not Yet.
Chores Toddlers Can Tackle The New Facts of Life
Handling Sucking Habits Now
WHAT IT’S IMPORTANT TO KNOW: The Superchild Syndrome Introducing the ABC’s and 1, 2, 3’s Nurturing the Scientist in Your Toddler Signs of the Superchild Syndrome
What About Those Little White Lies?
Take a Good Look at Your Toddler’s Skin At Greater Risk Under the Sun Decoding SPFs Types of Diaper Rash Gummy Hair Spotting Vision Problems
Checking Your Toddler’s Eyes What’s Too Loud? Pierced Ears Signs of a Hearing Problem Fluorides for Fighting Decay The In-Again, Out-Again Testicle
White Whole Wheat? The Frosting on the Flakes Variety Is More Than the Spice of Life
Fat Sense Milk Measures
Juice Facts
Sample Toddler Menu The Broccoli Connection Maybe They Really Do Grow Overnight How Does Your Toddler Grow?
TACTICS FOR THE TABLE
Fast Food—Fun or Folly?
Gratifying a Snack Attack
Fun with Food Dairy Protein Choices for Toddlers Vegetarian Protein Choices for Toddlers
SAFE FOOD, SAFE WATER
Dining Out With a Toddler The Cutting Board Dilemma Choking Risks
HAPTER
INETEEN LL BOUT OILET EARNING
C N : A A T L
Potty Patience, Please
’Tis the Season?
Hygiene Hype
HAPTER WENTY EEPING OUR ODDLER EALTHY
When to Call the Doctor After an Immunization
Don’t Miss an Opportunity AAP Immunization Recommendations Immunization Myths—Dispelled
The Role of the Pediatric Nurse-Practitioner Looking for Dr. Right Appendicitis Warnings Parent’s Intuition
Know Your Toddler Febrile Convulsions Dosages for Acetaminophen and Ibuprofen Typical Body Temperatures
Herbal Remedies Out-of-Date Medications Aspirin or Non-Aspirin?
Nose Blowing Toddler Tummy Signs of Dehydration Preventing the Spread of Illness Tubes for Toddlers
Tonsils and Adenoids: Taking Them Out Is No Longer In
One Picture is Worth ...Treating Your Toddler’s Symptoms
HAPTER WENTY NE EEPING OUR ODDLER AFE
C T -O : K Y T S
Dressing for Safety Lead Can Lead to Trouble
Food for Thought Safe Heights No Gun Is a Safe Gun Indoor Pest Control: Sorry for Pests, Still Safe for Toddlers Putting Worry in Perspective Poison Control
JPMA Certified Safe for Kids Designed for Safety
No Swinging
A Safe Place to Play Dress for It Don’t Let the Bugs Bite Let It Snow The Latch System Safe Art
Red Light Greenery
HAPTER WENTY WO REATING ODDLER NJURIES
Poison Guidelines You Shold Know Stocking the Medicine Chest Making a Boo-Boo Better Bandaging a Boo-Boo Tender Loving Care
Cardiopulmonary Resuscitation (CPR): Children Over One Year
Free Testing Who Can Help?
It’s the Law Residential Care Home Care
Helping the Healthy Sibling Life-Threatening Allergies When the Food-Allergic Toddler Steps Out Hearing Tests The Very-Low-Birth-Weight Baby as a Toddler
Siblings 101 Stepping into a Stepfamily Play It Safe
Walk a Yard in Your Toddler’s Shoes Keeping Your Cool One-on-One for Fun Back Relief When Your Heart’s at Home, but You’re at Work Having It All—Your Way
Staying Sane in the Fast Lane Leaving Home Without Your Toddler Happy Holidays Parents vs. Grandparents Get a Doctor Talking About Death Deciding About the Funeral
Sharing a Baby-sitter Preschool: Who Needs It?
Baby-sitter Plus Child Signs of Substance Abuse in a Caregiver Sources of Help and Information Preschool Admissions
The Sick Child and Child Care
Recognizing Abuse
Humidifying
FOREWORD
A Pediatrician’s Prescription
This wonderfully informative book is destined to win blue ribbons for authoritativeness, readability, and usefulness. One of the things that impressed me most as I read it was how thoroughly it prepares parents to understand the needs, behavior, and development of their toddlers, while offering hundreds of valuable suggestions on their care, guidance, and management. (Perhaps that last word should be in quotes. With toddlers, it’s never really clear who manages whom.)
But What to Expect the Toddler Years is more than a user-friendly technical handbook. The authors present the developmental essentials of the difficult but delightful toddler years in such an accessible and empathic manner that appreciative parents will undoubtedly recommend this book to their friends as a genuine household necessity.
It has become increasingly clear that a child’s first three years of life largely determine his or her future developmental trajectory. To a large extent, these early years set the stage for later outcomes in personal health, emotional development, educational attainment, social competence, self-confidence, self-reliance, and positive human relationships. Parental investment in the coin of nurturance, care, love, and understanding during this formative age period brings both short- and long-term dividends.
This latest addition to the What to Expect series helps parents to achieve these dividends in several ways. It helps parents know what to expect from their toddlers at various ages and stages, and reassuringly maps the wide range of normality. It guides parents in the always challenging, often daunting task of helping the toddler deal successfully with such key developmental issues as good nutrition, timely immunization, safe play, sound sleep, weaning, speech, separation, self-discipline, good health and hygiene habits, as well as various child-care situations.
Considerable attention is given to practical suggestions for the prevention of behavioral and developmental problems. But the authors not only help parents to avoid the negative, they strongly accentuate positive values with innumerable sidebars devoted to the care and nurturing of the toddler’s understanding of right, wrong, and the gray areas in between.
Temper tantrums? Breath-holding spells? Sleep disorders? Biting? Short attention span? Speech delay? Toileting worries? Autonomy? Negativity? Resistance to limits? Along with why such behavioral and developmental problems happen, detailed guidance is offered on ways to get them to stop—or at least to minimize them. These recommendations are developmentally based, in keeping with the child’s chronological age, needs, and abilities.
Parents themselves are not neglected. A principal goal of the book is to provide frequently overwhelmed and sometimes despairing parents with the kind of information that promotes confidence, self-esteem, resiliency, and feelings of effectiveness. Common parental questions (including those of parents working outside the home) are posed and comprehensively and reassuringly answered. Parent–toddler interaction and communication are strongly promoted as ways to give a young child and his or her parents a good start. Throughout the book, the toddler is viewed in the context of his or her family, with an emphasis on identifying and augmenting the strengths of both.
The authors’ thoughtful advice and suggestions are intended to help readers enjoy their toddlers— to take a positive approach to the challenges of their formative years, to understand what often seem to be (but often aren’t) irrational behaviors and to put them in perspective, to accept and respect each child as a unique individual and contribute to the realization of that child’s potential.
This book directly responds to the sensible desire of today’s parents for information that fits our times, a period characterized by rapid changes in the family and our society. This highly skilled synthesis of childrearing principles, savvy from the social, behavioral, and biologic sciences, and successful medical practice is clearly unsurpassed among child-care guides. It is an outstanding volume—one that will be extremely useful to both parents and professionals.
Morris Green, M.D., F.A.A.P. Perry W. Lesh Professor of Pediatrics Indiana University Medical Center
INTRODUCTION
A Tale of “Two” Toddlers
It was the best of the times, it was the worst of times. It was Emma’s toddler years.Shoes hurled across the room because they didn’t “feel good” on her feet. Crackers rejected because they had a corner broken. A swimsuit donned on a frigid January morning, a snowsuit donned on a scorching August afternoon. Sit-down strikes on grimy New York City sidewalks (when there was no bus in sight), lie-down strikes in front of the candy display at the supermarket (when sweets weren’t on the shopping list). Daily tantrums, nightly sleep problems; battles fought at the dinner table (“Don’t wanna eat that!”), at the closet (“Don’t wanna wear that!”), at the playground (“Don’t wanna go yet!”). Stubbornness that wouldn’t quit, a temper to rival a marine drill sergeant’s, ritualistic behavior that bordered on the obsessive–compulsive.
And then, there was that smile—a smile that, in one endearing flash of pearly baby whites, could turn a hardened parental heart into a helpless pool of sentimental slush. And those hugs—spontaneous outbursts of unaffected affection more delicious (and more addictive) than imported chocolate truffles. And that voice—cuter than a voice has a right to be, uttering achingly adorable mispronunciation after mispronunciation (“bia” for banana, “pe-um” for peanut butter, “ga-ga” for daddy). And those moments—those thousand-and-one enchanting moments, the ones that made me forget the tantrums and the negativity, that entertained me, charmed me, and made me feel blessed. The way she “nursed” her teddy bears while I nursed her baby brother. The way she poured “tea” for her dolls, and administered shots to sickly stuffed animals. The way she sang to herself while she swung on the swings, and babbled to herself while she flipped the pages of her picture books. The way she scoured the park for caterpillars and butterflies to catch and observe in her “bug house.” The way she moved, the way she cuddled, the way she laughed, the way she played, the way she slept.
If there has yet to be a more difficult time in the raising of Emma, there has also yet to be a more delightful one. Though I’ve thoroughly enjoyed every era of Emma (from newborn to preteen; I’ll get back to you on adolescence), the toddler years—more harrowing than any roller coaster ride, and yet, much more intoxicating; a series of ups and downs that at once confused, captivated, exasperated, and exhilarated—were among my favorite years.
Of course, that’s easy to say now—now that Emma has evolved from an irrational two-year-old to a reasonable (most of the time), responsible, and responsive eleven-year-old, now that I have nearly a decade of time-heals-all perspective between me and those shoe-hurlings (we never did find that sneaker). It was decidedly less easy to say, or to feel, when Emma was a toddler.
If only I’d understood then what experience has helped me to understand now. That, to paraphrase the popular (but unprintable) aphorism, toddler behavior happens. And it has to happen—as inevitably as those two front teeth, as surely as those first steps. It doesn’t happen because you’re bad parents, and it doesn’t happen because your toddler’s a bad child—it happens because it’s supposed to happen and because it needs to happen. Toddlers don’t do what they do to drive their parents to distraction (though that’s often the result); they do what they do to grow, to mature, to come to terms with coming of age.
So it is to those trying, terrific, irrepressible, irresistible, completely confounding creatures we call toddlers—and to the parents who struggle to understand them—that this book is dedicated. In hopes that it will help parents of toddlers appreciate the best of times, cope with the worst of times— enjoy all the times that are the toddler years.
Heidi Murkoff
Before You Begin
HAT TO
How to Use W E T Y
When it comes to parenting, there are few absolutes (one, of course, being that every child needs to be loved) and there is no one “right way” (with the exception of issues that affect a child’s safety and health). Use this book for suggestions, for insights, for explanations, for examples—but use it to supplement and support rather than supplant your own instincts. Let it inspire you, not inhibit you. Different parenting techniques work for different children (even for different children within the same family, and the same child under different circumstances); different parenting styles suit different parents and the same parent at different times of life. Let this book serve as a guide as you use your skills, talents, instincts, and knowledge of yourself and your child (no one knows you and your child as well as you do) to try to discover what works best in your family.
What Your Toddler May Be Doing Now
Every child is unique; each develops at his or her own pace. Because few children are perfectly average or typical, comparisons are not very useful. And though we may be concerned about the child who lags behind his or her peers, that child may later make great leaps forward, catching up or even surpassing them.
Nevertheless, most of us want to know how our own child is doing in relation to other children, at least once in a while. To help you determine where your toddler’s development fits within the wide range of normal, we’ve developed a monthly milestone scale of achievements for the second year, and a quarterly milestone scale for the third year, into which virtually all toddlers fall. These scales are based on the widely respected Denver II scale, with a few added items from the well-regarded ELM (Early Language Milestone) scale.
Here’s how they work: Each “What Your Toddler May Be Doing Now” milestone scale is divided into four categories. The first, “What your toddler should be able to do,” lists milestones that have been reached by 90% of toddlers by that age. The second, “What your toddler will probably be able to do,” represents milestones that have been reached by 75% of toddlers. The third, “What your toddler may possibly be able to do,” includes milestones that have been reached by 50% of children. And the fourth, “What your toddler may even be able to do,” includes milestones reached by 25%.
Most parents will find their toddlers achieving in several different categories at any one time. Some may find that their offspring stay consistently in the same category; others may find their child’s overall development uneven—slow one month, vaulting ahead the next.
All of these developmental styles are perfectly normal until proven otherwise. Still, there are times when a doctor should be consulted. For example, when a child consistently fails to achieve what a child of his or her age “should be able to do,” or when a parent has a gut feeling that something isn’t right with a child’s development. Even then, though an evaluation may be a prudent step, it may turn out that no problem exists. Some children keep moving forward but simply have a slower than average developmental timetable.
Use the “What Your Toddler May Be Doing Now” sections of this book to check progress periodically, if you like, but don’t use them to make judgments about your toddler’s potential—they are not predictive. If you find yourself obsessed with comparing your child to the averages, you may be better off looking at the milestone scales rarely, or not at all. Your child will develop just as well —and you (and your toddler) may be happier.
Keep in mind that the questions and issues discussed in each chapter are less specific to that month or period than was true in our book What to Expect the First Year. Be sure to use the index to help you find the answers to your concerns.
Also remember that toddlers, like babies, don’t develop in a smooth, linear progression. There are lots of bumps and humps, spurts and lulls. The period before a big step is often one of disorganization —nothing seems to go right; then all of a sudden, the child is walking or talking up a storm. Seemingly stagnant periods, in which there appears to be no progress at all, are actually spent polishing and expanding new skills; they are necessary to normal development. Progress may slow, too, or even slide backward, during times of stress. With adequate support at such times, toddlers usually get right back on the forward track.
A Note to Nontraditional Families
There’s more than one way to raise a family these days. Though the so-called “traditional” home —where a married couple raise the children together—is still perceived as the norm, half of all American children under eighteen are being raised in nontraditional homes. Sometimes by choice, more often by circumstance, more and more families are headed by single parents, usually mothers.
And while they’re still a small minority, other types of nontraditional families—including those headed by solo fathers, unmarried heterosexual or same-sex couples, mothers and fathers sharing custody in separate homes, and grandparents raising grandchildren—are also growing in number.
This book is meant for all kinds of families—traditional and nontraditional. For the sake of simplicity as well as syntax, we sometimes refer to the traditional family rather than trying to address every conceivable family configuration. But such references are not meant to exclude or offend those
PART ONE
The Second and Third Years
CHAPTER ONE
The Thirteenth Month
WHAT YOUR TODDLER MAY BE DOING NOW
By the end of this month:
pull up to standing position get into a sitting position cruise (move from place to place, always holding on) clap hands (play “patty-cake”) indicate wants in ways other than crying
Note: If your toddler has not reached these milestones or doesn’t use his or her hands for purposeful
activities like picking things up, consult the doctor or nurse-practitioner. This rate of development may well be normal for your child (some children are late bloomers), but it needs to be evaluated. Also check with the doctor if your toddler seems unresponsive, doesn’t smile, makes few or no sounds, doesn’t seem to hear well, is perpetually irritable, or demands constant attention. (Remember, the one-year-old who was born prematurely often lags behind others of the same chronological age. This developmental gap progressively narrows and generally disappears entirely around age two.)
. . . will probably be able to:
put an object into a container (by 12½ months) imitate activities (by 12½ months) stand alone (by 12½ months) use 1 recognizable word
. . . may possibly be able to:
drink from a cup use 2 recognizable words (by 12½ months) point to a desired object (by 12½ months) scribble walk well
. . . may even be able to: use a spoon/fork (but not exclusively) remove an article of clothing point to 1 body part when asked use an object in imitation
Intellectual development. Early in the second year, toddlers are explorers and scientists, picking up,
studying, testing, manipulating, maybe still putting in their mouths, everything in their path. Cause and effect is a major focus. They live in the here and now, and do not show much imagination or abstract thinking as yet.
Emotional development. As the world begins to open up, the toddler, who has come a long way from
the eat-cry-sleep newborn, opens up, too, displaying a wide range of moods, feelings, and behaviors.Expect them and accept them—they are part of growing up. This range includes displays of affection, independence, frustration, fear, anger, protest, stubbornness, willfulness, sadness, anxiety, and puzzlement.
WHAT YOU CAN EXPECT AT THE ONE-YEAR CHECKUP
Preparing for the checkup. Keep a list of concerns that have come up since the last visit to your
child’s doctor or nurse-practitioner. Be sure to bring the questions with you to this visit so you will be ready when the doctor asks, “Any concerns?” Also jot down new skills your toddler is displaying (clapping hands, waving bye-bye, throwing kisses, walking, climbing) so you won’t be at a loss when you’re asked, “What’s your toddler been doing?” Bring along your child’s home health history record, too, so that height, weight, immunizations, and any other information gleaned from the visit can be recorded.
What the checkup will be like. Procedures will vary a bit depending on your child’s doctor or the
nurse-practitioner who conducts health supervision exams, but in most cases, the twelve-month visit will include: An assessment of growth (height, weight, head circumference) since the last visit. These findings may be plotted on growth charts (see pages 862 to 865) and the child’s weight for height evaluated and compared to previous measurements. You can expect that the rate of growth will slow in the second year. Note that children don’t grow gradually, but rather in spurts. So your toddler may remain the same height for a couple of months, then suddenly pick up a full inch or more virtually overnight.
Questions about your child’s development, behavior, eating habits, and health since the last visit. There may also be questions about how the family is doing in general, whether there have been any major stresses or changes, how siblings (if any) are getting along with your toddler, about how you are coping, about child care arrangements (if any). The doctor or nurse will also want to know whether you have any other questions or concerns.
An informal assessment, based on observation and interview, of physical and intellectual development, and of hearing and vision.
A finger-stick blood test (hematocrit or hemoglobin) if the child is at risk of anemia. The test may be done once routinely between twelve months and four years.
If you live in an old home or apartment building, a blood test (blood is drawn and sent to a lab) may be given to check for lead. Some babies may be automatically tested at 1 year; others will be screened, depending on what kind of housing they live in.
A Mantoux tuberculin test (a simple skin test) for children at high risk for TB, such as those who have traveled abroad or have parents who work in a hospital or jail.
Immunizations.
Hib (hemophilus influenza b); may be given at 15 months instead.
Other need-to-know advice. The doctor or nurse-practitioner may also discuss such topics as good
parenting practices; your toddler’s emerging struggle for independence; discipline; communicating with your toddler; nutrition, weaning, and fluoride supplementation, if appropriate; injury prevention; ways of stimulating language; and other issues that will be important in the months ahead.
The next checkup. If your toddler is in good health, the next visit will be at 15 months. Until then, be
sure to call the nurse or doctor if you have any questions that aren’t answered in this book or if your child shows any signs of illness (see page 569).
WHAT YOU MAY BE WONDERING ABOUT
REQUENT FALLS F “Our year-old daughter can barely stay on her feet for five minutes at a time without falling. Is something wrong with her coordination?”
A toddler is an accident waiting to happen . . . and happen . . . and happen again. Surefootedness is not characteristic of new walkers (which is why, of course, they are called toddlers); most fledgling toddlers can’t even make it across a room without taking a flop.
Part of the problem is a lack of experience with balance and coordination, which take a lot of practice to perfect. (If you’ve learned to ice-skate or ride a bike as an adult, you have an inkling of what learning to walk must be like.) Another factor is farsightedness; most children this age can’t clearly see what’s under their nose (see page 5). Judgment, or rather the lack of it, also contributes. So does preoccupation. A toddler is more likely to be paying attention to what’s going on around her than where she’s going. And since toddlers are rarely able to concentrate on more than one thing at a time, collisions and spills are the typical result.
Though she will continue to make steady progress in the months ahead, chances are your toddler will be cruising for a bruising for some time to come. It probably won’t be until somewhere around her third birthday that she’ll have gained the expertise necessary to be able to steer a steady course— most of the time.
A pair of soft, wide, elasticized pony-tail holders or wrist bands that fit comfortably (never snugly) around the ankles of sleepers will keep floppy feet from slipping up a toddler.
Meanwhile, since you can’t always prevent her from falling, the best you can do is work toward preventing falls and minimizing injury when she does fall. It makes sense to have your child do most of her walking on carpeted surfaces (obviously this is not feasible if your home isn’t carpeted), and to keep her away from such extra-hard surfaces as slate, ceramic tile, stone, and brick. Check any areas she frequents for sharp corners and other protuberances and cover or remove them (see page 626). Keep drawers, furniture doors, and appliances (especially dishwashers) closed when she’s around; eliminate or tape down dangling electric cords; and temporarily remove rickety chairs or tables (which she might grab onto for support). Areas where falls could be particularly dangerous, such as stairs and bathrooms, should be made completely inaccessible (see page 620).
Protective clothing can help, too. When practical opt for long pants instead of shorts or dresses. Heavy corduroy and quilted fabrics cushion falls more effectively than do thin cotton knits. And while you’re outfitting her, make sure your toddler’s footwear isn’t contributing to the trouble she’s having staying upright. Floor temperature permitting, bare feet are best indoors; if socks or slippers are necessary, they should be nonslip. When only shoes will do, make certain that the soles provide enough traction to prevent slipups and that the shoes fit correctly. (Shoes that are too big or too small can trip up a toddler. See page 8 for more on toddler shoes.)
If your toddler is a climber, putting some cushions or soft mats at the base of her favorite “mountains” can make for a happier landing should she lose her footing. Remove or bracket to the wall any furniture (including freestanding bookcases) that could topple if she climbed on it. close to the ground and usually still well-cushioned with baby fat. The skull is flexible because the soft spot (or fontanel) hasn’t closed completely (it doesn’t generally close fully until somewhere around eighteen months), so a toddler can generally take slight bumps to the head without damage. Overprotecting your toddler in order to prevent falls (penning her up in a playyard for hours at a time, for example) is unwise. A toddler has to take some falls in order to master staying on her feet.
SAFETY WARNING
Some particularly adventurous toddlers learn how to climb out of their cribs early in the second year. So if you haven’t already lowered your child’s crib mattress to its lowest level, do so now. Also be sure to keep out of the crib large stuffed animals or other objects that your toddler can utilize as stepping stones to freedom—and a bad fall.
Overprotecting your toddler and overreacting when she does fall (“Oh, my poor baby!”) may also inhibit her natural drive to explore, slow her gross motor development (walking, jumping, climbing), and make her needlessly fearful.
UMPING INTO THINGS B “My son constantly bumps into things—tables, chairs, people. Could something be wrong with his eyesight?”
Probably not. Typically, the one-year-old is somewhat farsighted and possesses limited depth perception, so judging distances at this age can be tricky. By age two, normal vision improves to about 20–60; by three to about 20–40. It’s not until roughly age ten that normal 20–20 vision is attained. (See page 478 for possible signs of vision problems.)
Even if a toddler did possess perfect vision, chances are he still couldn’t see his way clear of collisions. That’s because he rarely looks where he’s going. Preoccupied with the mechanics of walking, he often looks at his feet (to make sure one’s still going in front of the other) instead of at where they’re taking him. Or he focuses his attention on the person or object he’s trying to reach—the stuffed giraffe that’s lying on the sofa, a parent beckoning from across the room with outstretched arms, the fascinating dials of the television set—and not on the obstacles that may be lying in his path. It’s not surprising that he careens into the floor lamp, barrels into the coffee table, or stumbles over the dump truck he’s left in the middle of the floor. And even if he does spy a roadblock at the last minute, he may not possess the ability necessary to go around it or stop short of it, especially if he’s picked up some speed.
Fortunately, both vision and coordination sharpen with time. Around his third birthday, you can expect your toddler to begin navigating his world more steadily and more safely. True grace, however, will probably elude him until the age of eight or nine—at the earliest.
Until then, you can protect him from some of life’s little bumps by making his environment safe (see page 622).
LOW GROSS MOTOR DEVELOPMENT S
“Our little girl was the last one in her play group to roll over and to sit up. Now even though she’s a year old, she still hasn’t
pulled up to standing. Everything else (speech, hand coordination, and all) seems normal. The doctor says ‘don’t worry,’ which
is easy for her to say. . . .”Just about every parent worries sometimes—it’s part of the job description. And usually, being told not to worry—even by your child’s doctor—isn’t enough to calm parental concerns completely. If, in spite of the doctor’s reassurances, your gut feeling tells you to pursue the matter further, explain that you would be more comfortable if your baby had an assessment to rule out any problems. The doctor is likely to agree, if only to set your mind at ease. It may well turn out that your daughter’s gross- motor development (the development of the large muscles of the body that are involved in crawling, sitting, standing, climbing) is just on the slow side of normal and that she’ll gradually catch up with her playmates on her own. In that case, you may be able to help speed the process along in the ways recommended below. Rarely, such tests uncover a motor problem that would benefit from extra attention. When poor muscle tone is at the root of slow motor development, physical therapy can be very beneficial, especially if started at an early age. In fact, with appropriate intervention (usually consisting of a variety of do-at-home physical-therapy exercises) many children with gross-motor delays eventually catch up and do just fine.
LOWPOKE WALKER S “I really thought that by now my son would have started walking. But he hasn’t even tried yet.”
The fact that your son hasn’t yet started training for the toddler Olympics doesn’t mean he isn’t destined to perform great feats on two feet. After all, the average baby doesn’t take those first momentous steps until he’s somewhere between thirteen and fifteen months of age. And though a few begin toddling around as early as seven or eight months, many completely normal youngsters don’t step out on their own until sixteen months or even later.
Where your child falls within this very wide range of normal development doesn’t tell you anything about his intelligence or his future athletic ability. Just like most slow talkers, most slow walkers catch up quickly once they get started—often breaking into a run just weeks after they’ve attempted their first tentative steps.